UC Irvine-led study finds heart disease top cause of pregnancy-related deaths in California

Heart disease is the leading cause of women’s pregnancy-related deaths in California — but nearly one-third could be prevented, according to UCI Health-led research presented at the recent American Heart Association’s Scientific Sessions 2013.

Maternal death rates have been increasing in California and the United States since the mid-1990s, according to statistics from the California Department of Public Health.

“Women who give birth are usually young and in good health,” said Afshan B. Hameed, M.D., the study’s lead researcher and associate professor of clinical cardiology, obstetrics and gynecology at the University of California, Irvine. “So heart disease shouldn’t be the leading cause of pregnancy-related deaths, but it is.”

She said the results likely apply to the rest of the United States.

California recorded 2.1 million live births from 2002-2005. Researchers analyzed medical records of 732 women who died from all causes while pregnant or within one year of pregnancy and found that:

• 209 deaths were pregnancy-related.
• 52 (about one quarter) of the pregnancy-related deaths were from some form of cardiovascular disease. Of note, only 6 percent had been diagnosed with a heart condition prior to the pregnancy.
• 33 (or two-thirds) of the cardiovascular-related deaths were from cardiomyopathy — a serious disease in which the heart muscle is weakened and can lead to heart failure, irregular heartbeats, heart valve problems and death.

Compared to women who died of non-heart-related causes, researchers found that:

• Women who were most likely to die from pregnancy-related heart disease were African-American, obese or had documented substance abuse during pregnancy.
• Nearly one-fourth of the women who died of cardiac causes had been diagnosed with high blood pressure during their pregnancies.

In about two-thirds of the deaths, the diagnosis was either incorrect or delayed, or providers had given ineffective or inappropriate treatments, researchers said.   One third of the patients who died had delayed or failed to seek care, 10 percent refused medical advice and 27 percent did not recognize their symptoms as cardiovascular.

“Women should attain and maintain proper weight before and during pregnancy, and talk to their doctors if they have personal or family histories of heart disease,” Hameed said. “And healthcare providers should be referring pregnant women who complain of symptoms consistent with cardiac disease to specialists, especially when these risk factors are present. Women with evidence of substance abuse should receive early referral for treatment.”

But, Hameed noted, it is impossible to know if earlier diagnosis and intervention would have prevented death in these cases “as missed cues to the presence of heart disease were common.”

Co-authors are Elyse Foster, M.D.; Christy McCain, M.P.H.; Christine Morton, Ph.D.; and Elliott Main, M.D. Author disclosures are on the abstract.

The California Department of Public Health, Maternal Child and Adolescent Health funded the study, with support from the California Maternal Quality Care Collaborative and the Public Health Institute.

Dr. Hameed is a Board Certified Cardiologist and Maternal Fetal Medicine Specialist. UCI Health is a leader in maternal fetal medicine and has one of California’s few combined regional perinatal/neonatal program to treat high-risk pregnancies, deliveries and newborns.  As many as 10 percent of pregnancies are considered high risk, but with expert care, 95 percent of these special cases result in the birth of healthy babies. UC Irvine Medical Center is the only facility in Orange County offering specialized care in one location for high-risk expectant mothers and their babies.

The American Heart Association is devoted to saving people from heart disease and stroke – America’s No. 1 and No. 4 killers. We team with millions of volunteers to fund innovative research, fight for stronger public health policies, and provide lifesaving tools and information to prevent and treat these diseases. The Dallas-based association is the nation’s oldest and largest voluntary organization dedicated to fighting heart disease and stroke. To learn more or to get involved, call 1-800-AHA-USA1, visit heart.org or call any of our offices around the country.  Follow us on Facebook and Twitter.  

UCI Health comprises the clinical, medical education and research enterprises of the University of California, Irvine. Patients can access UCI Health at physician offices throughout Orange County and at its main campus, UC Irvine Medical Center in Orange, Calif., a 412-bed acute care hospital that provides tertiary and quaternary care, ambulatory and specialty medical clinics, behavioral health and rehabilitation. U.S. News & World Report has listed it among America’s Best Hospitals for 13 consecutive years. UC Irvine Medical Center is home to Orange County’s only National Cancer Institute-designated comprehensive cancer center, high-risk perinatal/neonatal program, Level I trauma center and Level II pediatric trauma center, and is the primary teaching hospital for UC Irvine School of Medicine. UCI Health serves a region of more than 3 million people in Orange County, western Riverside County and southeast Los Angeles County. Follow us on Facebook and Twitter.